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TMJ Treatment

Serving Houston, Baytown, La Porte, Pasadena, and Port Arthur

There are many approaches to the treatment of TMJ dysfunction. Which modality is chosen depends on three things: the results of a comprehensive diagnosis, the personal circumstances of the person needing care, and the desired outcome of treatment. Depending entirely on the correct diagnosis, the actual treatment can range from very, very simple to extremely complex. For more information visit www.tmjhealth.com.

TMJ Treatment Options:

PHASE ONE
Palliative Therapy
Occlusal Therapy
Orthotics

PHASE TWO
Dental Orthopedics

PHASE THREE
Orthodontics
Restoration and Reconstruction
Surgery

Phase One

Palliative Therapy

Palliative therapy is a Phase One TMJ treatment designed solely to relieve pain associated with TMJ dysfunction. Dr. Wooten helps TMJ patients in Phase One effectively manage the physical symptoms for quick relief. Medications, nutritional supplements, proliferation therapy (Prolo), TENS, Iontophoresis, and physical therapy are all examples of palliative therapy techniques to assist patients with pain management.

Occlusal Therapy

Rarely, it will be found, after a thorough evaluation, that a single tooth or a very few teeth are causing interferences which precipitate TMJ dysfunction. It can be a rotated tooth, a mal-posed tooth, a mal-formed tooth or a number of other possibilities. If it has been shown through the diagnostic process that all the other criteria are within the range of physiological adaptation, then "spot grinding" of one or more teeth may be the preferred treatment. Discernment must be used in order to know which tooth to grind and where to grind it, so that relieving one interference does not create another interference in a different place.

Occlusal Equilibration

Occasionally, after a complete evaluation it will be found that a good number of teeth just don't function well together. In that case, the treatment of choice may be to do an occlusal equilibration of the entire mouth. However, this should always be performed first on stone models of the mouth, which have been mounted on a properly programmed articulator so that the correct teeth and the precise areas of adjustment can be determined. In this way, the dentist knows before hand, not only where and how much tooth structure will have to be removed, but also, exactly what the resulting function of the occlusion will be after the equilibration is completed.

Orthotics

Orthotic devices are removable acrylic appliances that are worn on the teeth and specially designed to fit the individual TMJ patient. They are adjustable and may offer a safe, non-surgical solution to TMJ pain. This type of treatment is often referred to as "occlusal splint therapy". This Phase 1 treatment is directed toward the symptoms of TMJ and only rarely, if ever, is it directed toward the underlying cause of TMJ dysfunction. Therefore, its primary use should be to get symptomatic relief right away in very acute TMJ cases, or to "buy time" until proper diagnosis and treatment can be begun. These occlusal splints may be used to assist in the diagnostic process when the symptoms are vague and don't fit the normal clinical pattern, or when the diagnostic findings are inconclusive. In those cases, a substantial reduction of symptoms from the use of the splint may confirm the validity of a TMJ dysfunction diagnosis.

Phase Two

Dental Orthopedics

Dental orthopedic treatment (whether used in TMJ or orthodontic treatment) is a non-invasive and progressive treatment consideration. Dr. Wooten uses a variety of custom-made orthopedic appliances to reduce muscle spasms, foster a comfortable jaw position, and to create the most ideal relationships possible between the bony structures of the jaws. Dr. Wooten uses sophisticated diagnostic information to create the correct neuromuscular positioning appliances for each patient. These customized mouthpieces offer relief from stress and pressure, adjust the jaw bones and muscles into a more comfortable position, and facilitate the remodeling of the jaw bones so that they may accommodate straight teeth that function ideally, and remain stable throughout the years after treatment.

Often times when the teeth are mal-aligned, the underlying reason for the mal-alignment is because the supporting bone is underdeveloped or inappropriately related to adjacent or opposing bone. With orthopedic orthodontics, the size, shape, and position of the supporting bone are addressed prior to straightening the teeth.

Body structures are in a dynamic position. That position is such because that is where all the forces which come into play are in equilibrium. All we have to do to effect the movement and or remodeling of the bone is to very lightly tip the balance of forces in favor of a more ideal or "correct position" for the bones of the skull and the entire masticatory system. Once movement and/or remodeling have begun, we orchestrate the movement of the bones into optimal relationships with each other and that results in a degree of function and comfort that is otherwise impossible to achieve.

Let's consider a condition where the teeth are very crowded. That occurs rarely, if ever, because the teeth are too large. However, traditional orthodontics has managed that situation by the removal of permanent teeth in order to attain adequate space for the remaining teeth. Even though that method may result in straight teeth, it most often also results in a caved in face and a very poor facial profile, especially later in life. It has also frequently resulted in the patient experiencing undue pain and suffering from TMJ dysfunction precipitated by the extraction orthodontics.

Phase Three

Orthodontics

Cranial-Mandibular Cervical (CMC) orthodontics is the next generation of what is sometimes called gnathologic orthopedics, or orthopedic gnathology, or orthopedic orthodontics. It is the most advanced and comprehensive form of treatment on the planet for orthodontic correction as well as TMJ dysfunction. The differences between CMC orthodontics and traditional orthodontics are extensive. It all begins with the diagnostic process. We do what is called a morphometric analysis that allows us to get an extremely accurate three-dimensional fix on the size and position of the bones as they relate to each other and to the skull. Once armed with that information, the particular type and design of appliance will be dictated by the correction that needs to occur in the underlying bone in order for the teeth to have adequate room to be straightened and to remain stable for years to come.

Therefore, the initial phase of CMC orthodontics is devoted to getting the bones of the jaws and the skull in their proper position and in an orthogonal (right angle) relationship with each other. Rarely, if ever, are permanent teeth removed with CMC orthodontics, and the use of "headgear" is virtually non-existent. Additionally, many cases which are considered "surgical cases" can be treated very nicely in a non-surgical manner and with a superior result. Although, CMC orthodontics is generally a two-phase treatment (orthopedic and orthodontic), rarely is total treatment time longer than that of traditional orthodontics. The only exception would be when the treatment objective is one that is completely unobtainable through traditional orthodontics.

CMC orthodontics also yields the most complementary facial profile, optimal TMJ health, an ideally functional occlusion, and a broad, beautiful smile.

Restoration and Reconstruction

Sometimes cases have all the orthopedic and orthodontic findings within normal limits and normal physiological adaptive range, but the teeth have worn excessively, or for some other reason have lost vertical dimension. Loss of vertical dimension is one of the most important factors in TMJ dysfunction and it must be restored for optimal health to exist. Sometimes, the only and/or best way to acquire adequate vertical dimension is by placing crowns on all the teeth or occasionally only the posterior teeth.

Again in this instance, it is mandatory that before any teeth are prepared for crowns, a diagnostic wax-up is completed on accurate dental models properly mounted on a fully adjustable and programmable articulator. This must be done so that the final result can be visualized and examined prior to any irreversible changes being made to the actual tooth structure.

Extreme attention to detail must be placed on the esthetics of the finished case with emphasis on the most visually pleasing result. Particular care must be taken to insure that the phonetics of the finished case is also ideal. In other words, it is not acceptable for the patient to hiss or whistle when making "s" sounds in their normal speech. Likewise, additional care must be taken to allow the "f" and "v" sounds to be normal and comfortable for the patient to pronounce.

Surgery

Surgery is an option that is rarely indicated for TMJ dysfunction. As a rule, it should be considered only as a last resort. If there has been an accident where the jaws have been fractured, then surgery is often indicated. Rarely, there will be a "bone spur" or some other anomaly of the bone, which can only be corrected surgically.

David Wooten's experience has been that rarely, in the case of TMJ dysfunction, has surgical joint replacement or disc replacement resulted in a satisfactory condition. Occasionally, like the television shows have demonstrated, the results have been total nightmares for everyone involved.

Click here to learn more about The Logic Behind Dr. Wooten’s Diagnosis and Treatment Recommendations.

Find out how TMJ / TMD treatment options can eliminate pain and soreness and restore your healthy bite. Call experienced TMJ dentist Dr. David R. Wooten today for more information on TMJ treatment.